Healthcare Provider Details

I. General information

NPI: 1427025238
Provider Name (Legal Business Name): IVA RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 HIGHWAY 81 S
IVA SC
29655
US

IV. Provider business mailing address

PO BOX 519
IVA SC
29655
US

V. Phone/Fax

Practice location:
  • Phone: 864-348-6195
  • Fax: 864-348-7117
Mailing address:
  • Phone: 864-348-6195
  • Fax: 864-348-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number007
License Number StateSC

VIII. Authorized Official

Name: MRS. LINDA J BURDETTE
Title or Position: CHAIRMAN OF THE BOARD OF DIRECTORS
Credential:
Phone: 864-348-6195